Post Radation Dental Lesions
Pract Radiat Oncol. 2011;1(3):142-148.
Source
University of Missouri-Kansas City School of Dentistry.
Abstract
PURPOSE:
To
evaluate the severity of post-radiation dental lesions and possible
correlation with radiation dose to the teeth in patients treated for
head and neck cancers.
METHODS AND MATERIALS:
Data
from 93 head and neck radiotherapy patients treated between 1997 and
2008 were analyzed retrospectively. The main effect, radiation dose to
the individual teeth, was evaluated with covariates of elapsed time
after radiation, xerostomia, topical
fluoride use, and oral hygiene status included. Patients' radiotherapy
plans were used to calculate cumulative exposure for each tooth.
Patients' teeth were evaluated using a validated index and then
categorized as having none/slight or moderate/severe post-radiation
damage.
RESULTS:
Patients
(31 females, 62 males) ranged in age from 18-82 yrs (mean=57). The
number of teeth/patient ranged from 3-30 (mean=20) with a total of 1873
teeth evaluated. Overall, 51% of teeth had moderate/severe damage, with
the remaining having little or none. Using odds ratios and 95%
confidence intervals, the odds for moderate/severe damage were 2-3x
greater for teeth exposed to between 30-60 Gy as compared to no
radiation. However, for teeth exposed to ≥60 Gy as compared to no
radiation the odds of moderate/severe tooth damage was greater by a
magnitude of 10 times.
CONCLUSIONS:
The results indicate that there is minimal tooth damage below 30 Gy
(salivary gland threshold), a greater than 1:1 increased dose-response
between 30-60y likely related to salivary gland damage, and a critical
threshold of ≥60Gy which may be linked to direct effects of radiation on
tooth structure. These findings suggest that care should be taken
during the treatment planning process to limit tooth dose, and when clinically possible to limit tooth dose to less than 60 Gy.
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